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Evidence summaries

Crp Point-of-Care Testing in Maxillary Sinusitis and Lower Respiratory Tract Infection (Lrti)

In general practice, CRP point-of-care testing compared with non-testing is effective in decreasing antibiotic prescriptions for lower respiratory tract infection (LRTI) and acute maxillary sinusitis. Level of evidence: "B"

The quality of evidence is downgraded by imprecise results (wide confidence intervals).

Summary

A Dutch family practice study 1 included 32 physicians and 258 patients (107 with LRTI and 151 with rhinosinusitis). Patients were individually randomized to CRP assistance or routine care (control). Primary outcome was antibiotic use after the index consultation. Secondary outcomes included antibiotic use during the 28-day follow-up, patient satisfaction, and clinical recovery.

Patients in the CRP-assisted group used fewer antibiotics (43.4%) than control patients (56.6%) after the index consultation (RR = 0.77; 95% CI 0.56 to 0.98). This was true for both patient groups: rhinosinusitis 45.2% vs. 60.3% and LRTI 41.1% vs. 51.0%. This difference remained significant during follow-up (52.7% vs 65.1%; RR = 0.81; 95% CI 0.62 to 0.99). Delayed prescriptions in the CRP-assisted group were filled only in a minority of cases (23% vs 72% in control group, P < .001). Recovery was similar across groups. Satisfaction with care was higher in patients managed with CRP assistance (P = .03).

In an observational study by Danish GP:s 2, a group of GPs registered all contacts (n = 17 792) with patients who had respiratory tract infections during a 3-week period. GPs who used a CRP rapid test were compared with GPs who did not, and the treatment of their patients (n = 1444) with suspected sinusitis was compared. A CRP rapid test was used by 77% (n = 281) of the GPs. In the group of GPs using a CRP rapid test, the rate of antibiotic prescribing for sinusitis was 59% (95% CI 56 to 62) compared with 78% (95% CI 73 to 82) in the group of GPs who did not use a CRP test. The antibiotic prescribing rate for patients with tonsillitis and otitis did not differ significantly between the two froups of GPs. Performing a CRP rapid test was the factor that exerted the greatest influence on whether the patients were prescribed antibiotics, and the level of CRP had a strong influence on the prescribing rate.

Clinical comments

Note

Date of latest search: 2012-05-14

    References

    • Cals JW, Schot MJ, de Jong SA et al. Point-of-care C-reactive protein testing and antibiotic prescribing for respiratory tract infections: a randomized controlled trial. Ann Fam Med 2010;8(2):124-33. [PubMed]
    • Bjerrum L, Gahrn-Hansen B, Munck AP. C-reactive protein measurement in general practice may lead to lower antibiotic prescribing for sinusitis. Br J Gen Pract 2004;54(506):659-62. [PubMed]

Primary/Secondary Keywords